The casino is a world onto itself. There are no windows, no clock, but there are flashing lights, and the din of clacking coins and whirring slot machines. Beyond the slots, figures are mesmerized at the crap table. Interest in poker hit new heights with televised Texas Hold ‘Em tournaments. For the majority of gamblers, this is excitement, recreation, a fun diversion or escape from the ordinary and a chance to beat the odds. For others, an estimated three percent of the adult population, it’s an addiction, an endless roller coaster of excitement and despair.

A pervasive characteristic of addiction of any kind is that the repeated behaviors have led to a range of negative consequences. This may be putting it mildly in the case of pathological gambling, because someone in the grips of compulsive gambling usually suffers severe blows to finances and relationships before seeking help. His or her life may be in shambles.

Often the compulsive gambler’s denial leads him to believe that the next round will save the day. Of course, if the numbers come up right, the cash or credit won is then “invested” again. Gambling addiction is hardly a recent development, but the advent of electronic poker and the break-neck speed of today’s slot machines, as well as Internet gambling have actually sped up the time it takes to gamble for fun and when it slips into problematic, then compulsive behavior.

Pathological gambling, like other addictions, is both a biological and a behavioral disease. While we don’t know all the factors leading to gambling addiction, they often include social, family and psychological elements. We do know that the brain neuropathways involving the brain’s mechanisms are affected in an individual’s perception of rewarding experiences. The emotional escape that an individual finds in gambling may become entrenched.

We have seen from 15-20 percent of patients who suffer from cross-addictive disorders, such as alcoholism or drug dependency with problem gambling. Some estimates state that 35 percent of those with substance abuse or dependence also have met the diagnostic criteria for pathological gambling at some point in their lives. The SOGS (South Oaks Gambling Screen) is the accepted psychosocial diagnostic tool to identify a gambling problem and its progression.

Both substance and gambling addiction are progressive diseases, and may be characterized by inability to control impulses (to use or to gamble) denial, anxiety mood swings and depression and the need for instant gratification. Gambling, like chemical dependency, offers euphoric highs, which are inevitably followed by emotional valleys and usually remorse and shame. A major difference in gambling versus substance addiction is that the alcoholic or drug addict doesn’t believe the substance is the answer to recovery and to his problems, while the compulsive gambler believes the Big Win will be the answer to all his problems.

Gambling addictions can also result in symptoms such as blackouts and sleep disorders and hopelessness. Divorce, relationship and work problems, even arrests are some devastating consequences of compulsive gambling. A person’s general health is often neglected, including medical conditions that have been ignored. Gambling addiction is certainly a family disease, creating a dysfunctional family system that revolves around the individual’s addiction. Children may be emotionally stranded as well as physically neglected. Kids are affected long term too, with studies estimating 35 to 50 percent of children of pathological gamblers eventually experiencing gambling problems of their own.

It is important that when chemical and gambling addictions co-occur, they are treated at the same time. Like chemical dependency, gambling addiction is addressed in holistic treatment based on the Twelve Step Philosophy. Treatment is individualized and takes into account issues of gender and age.

Gambling: is it the money?

Some experts, including Dr. Henry Lesieur, St. John’s University, NY, who co-authored the SOGS screening assessment, believe it isn’t really about the money, even though money becomes a looming issue. Seeking action seems to be the major impetus for many. Being in action may be similar to the high of taking cocaine. “Chasing losses” is term use by habitual gamblers to describe attempting to recoup the gambling losses by winning. The action gambler usually likes to gamble on site, at a casino, racetrack, or other “live” venue. Often they are identified by casinos as “high rollers” and received comped rooms and meals. Others, though, don’t gamble for action so much as numb their feelings with compulsive gambling, so it becomes the ultimate, albeit temporary escape.

Age and gender as factors

A study by University of Connecticut Health Center psychiatrists published in 2002 evaluated gamblers seeking treatment and found significant differences by age and gender in pathological gamblers. Middle aged (aged 36-55) and older gamblers tended to include more women, at 45-55 percent, than younger gamblers (aged 18-35) at 23 percent. Middle aged and older women didn’t begin gambling regularly until the age of 55, while older men reported a habit of lifelong gambling. Perhaps surprisingly, the women also wagered greatest amounts in the month prior to treatment. Younger gamblers reported most problems with substance abuse, social and legal problems, while older gamblers found more employment-related problems.

There is hope for recovery

Pathological gamblers, like others who suffer from addiction can and do recover. Cognitive Behavioral Therapy, with Rational Emotive Behavioral Therapy, can change unhealthy behaviors and thoughts, including false beliefs, rationalizations, and self-destructive feelings. Dialectical Behavioral Therapy also helps individuals to meet life on its own terms rather than escape painful emotions with compulsive addictions.

A holistic treatment program that addresses the root issues of addiction as well as any co-occurring disorders is an effective approach that treats the whole person. Continuing care may be essential, especially for impulse control, as well as ongoing participation in support groups such as Gamblers Anonymous. The recovering gambler may also need professional financial advise, and family therapy can help to develop a supportive, healthy family structure for sustained recovery.